Credentialing AnalystPrimary Location: San Diego, CA
Additional Locations: CA-San Diego Apply
- Maintains high production and quality factors.
- Participates in development of credentialing processes and workflows. Identifies improvement opportunities and recommends enhancements and workable solutions.
- Provides telephonic education to providers/producers on credentialing policies and procedures. Identifies and communicates trends (quality of results, efficiencies of processes).
- Researches and prepares risk sensitive or complex business review/credentialing verification items for CPC.
- Reviews completed investigative files of co-workers for completion and accuracy.
- Manages vendor on-line access of primary verification sources.
- Provides ongoing support to department members in completing research and analysis to resolve complex issues raised by providers/producers and other internal/external customers.
- Directly contacts providers/producers and/or outside entities to clarify data quality issues.
- Provides issue resolution for providers/producers, during the credentialing or data management processes.
- Responds to network or provider/producer inquiries, including contracting and credentialing policy, procedures, credentialing status.
- Perform data entry and systems maintenance as needed; align data across systems.
- Ongoing License Sanction monitoring and reporting to minimize corporate risk.
- Track record of prioritizing work, multi-tasking, and managing workload efficiently.
- College degree or equivalent work experience preferred.
- High School Diploma or G.E.D.
- Possesses a working knowledge of Business Review/Credentialing processes, EPDB, EPC and CARDS.
- Ability to consistently meet and/or exceed performance/production goals.
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